The purpose of this study is to determine whether itacitinib is safe and effective in the treatment of systemic sclerosis in adults.
Systemic sclerosis (SSc) is a rare systemic autoimmune connective tissue-disease characterized by fibrosis, inflammation, and vasculopathy. SSc is responsible for skin fibrosis that can either be limited or diffuse. The latter phenotype of the disease is commonly associated with visceral involvement and therefore similar to graft versus host disease (GvHD) reaction. It can be life threatening in case of pulmonary or cardiovascular involvement. Nonetheless SSc remains a severe disease responsible for important disability and a poor quality of life. There is a growing body of evidence that supports the implication of the JAK-STAT tyrosine kinases pathway in the activation of fibroblasts of patients with SSc. A genetic polymorphism of STAT4 was found to be associated with the diffuse form of the disease and inhibition of STAT4 gene is associated with a decrease in TGF-ß and IL-6 cytokines activation, which are two major cytokines implicated in SSc pathogenesis. Recently, Pedroza et al. confirmed the implication of STAT3 in skin fibrosis mechanisms. Indeed, the authors showed an enhanced activation of STAT3 and demonstrated in vivo that the inhibition of STAT3 phosphorylation prevented skin fibrosis in a murine model of SSc. These data were confirmed by a work of Zhang et al. who showed that the inhibition of JAK1 was also needed to prevent skin and lung fibrosis. Altogether these works confirmed the implication of the JAK pathway in fibrosis mechanism. Itacitinib is a Janus kinase inhibitor that specifically targets JAK1 and decreases STAT3 phosphorylation. Itacitinib was shown to efficiently treat patients with myelofibrosis, rheumatoid arthritis, and chronic plaque psoriasis. Very interestingly, itacitinib efficacy has also been reported in patients with acute GvHD. Altogether these data and studies reinforced the investigator's working hypothesis. The efficacy and safety of this proposal must be tested.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
74
200 mg oral for 360 days
200 mg oral for 360 days
Change in modified Rodnan skin score (mRSS) at 360 days
performed by the same investigator at day 0 and day 360 and the change in mRSS will be calculated following the formula: ΔmRSS= mRSSd360 - mRSSd0. To measure mRSS, skin thickness of the patient is rated by palpation at each of 17 anatomic sites using a scale of 0-3 (0 = normal skin; 1= mild thickness; 2= moderate thickness; 3=severe thickness with an inability to pinch the skin into a fold). The scores at each site are summed with a minimum of 0 and a maximum of 51 (17 sites)
Time frame: 360 days
Incidence of death
Time frame: at 180 and 360 days
Incidence of Adverse Events
according to the Common Terminology Criteria for Adverse Events (CTCAE) toxicity grading scale
Time frame: at 180 and 360 days
Incidence of Severe Adverse Events
according to the Common Terminology Criteria for Adverse Events (CTCAE) toxicity grading scale
Time frame: at 180 and 360 days
Change in modified Rodnan skin score at 90, 180, 270 days
Time frame: at 90, 180 and 270 days
Proportion of patients who improved mRSS at 90, 180, 270 and 360 days
Time frame: At 90, 180, 270 and 360 days
Proportion of patients with an active disease according to the European scleroderma trials and research group (EUSTAR)SSc activity score at 90, 180, 270 and 360 days
EUSTAR SSc activity index score from 0 to 10 - a cut-off ≥ 2.5 identifies patients with active disease
Time frame: At 90, 180, 270 and 360 days
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CH Amiens
Amiens, France
RECRUITINGCHU Angers
Angers, France
RECRUITINGCHU Annecy
Annecy, France
RECRUITINGCHU Besançon
Besançon, France
RECRUITINGAvicenne Hospital
Bobigny, France
RECRUITINGCHU Bordeaux
Bordeaux, France
RECRUITINGCHU Bordeaux
Bordeaux, France
RECRUITINGAmbroise Paré hospital
Boulogne-Billancourt, France
RECRUITINGHôpital de la Cavale Blanche
Brest, France
RECRUITINGCHU Caen
Caen, France
RECRUITING...and 36 more locations
Change in the Combined Response Index in Diffuse Systemic Sclerosis (CRISS) score
composite response index
Time frame: At 180 and 360 days
SSc disease activity
* Physicians visual analogue scale range from 0 (min) to 10 (max) - 0=no activity, 10=maximum activity * Patients visual analogue scale range from 0 (min) to 10 (max) - 0=no activity, 10=maximum activity
Time frame: At 90, 180, 270 and 360 days
Short Form-36 (SF-36) health questionnaire
self-administered questionnaire of 36 items assessing the following 8 domains : physical functioning, bodily pain, role limitations attributable to physical health problems, general health perceptions, mental health, role limitations to emotional problems, vitality and social functioning (scale from 0 to 100)
Time frame: At 0, 15, 90, 180, 270 and 360 days
EurolQol-5Domain (EQ-5D) health questionnaire
self reported measure of quality of life - (scale from 0 to 100)
Time frame: At 0, 15, 90, 180, 270 and 360 days
Health Assessment Questionnaire Disability Index (HAQ-DI) scale
self administered 20 questions- score range from 0 (no disability) to 3 (severe disability)
Time frame: At 0, 15, 90, 180, 270 and 360 days